Heikura Ida A, McCluskey Walter T P, Tsai Ming-Chang, Johnson Liz, Murray Holly, Mountjoy Margo, Ackerman Kathryn E, Fliss Matthew, Stellingwerff Trent
Canadian Sport Institute Pacific, Victoria, British Columbia, Canada
Exercise Science, Physical & Health Education, University of Victoria, Victoria, British Columbia, Canada.
Br J Sports Med. 2024 Dec 23;59(1):24-35. doi: 10.1136/bjsports-2024-108121.
This cross-sectional retrospective and prospective study implemented the 2023 International Olympic Committee Relative Energy Deficiency in Sport (REDs) Clinical Assessment Tool version 2 (CAT2) to determine the current severity of REDs (primary outcome) and future risk of bone stress injuries (BSI, exploratory outcome) in elite athletes.
Female (n=143; 23.3±4.3 years) and male (n=70; 23.1±3.7 years) athletes (performance tier 3 (52%), tier 4 (36%), tier 5 (12%)) participated in a baseline CAT2 (with minor modifications) assessment, including a self-report questionnaire (menstrual function (females), BSI, Eating Disorder Examination Questionnaire (EDE-Q)), bone mineral density (BMD via DXA) and fasted blood analysis (triiodothyronine (T3), testosterone, cholesterol). Athletes were assigned a green, yellow, orange or red light via CAT2. The prospective risk of new self-report of physician-diagnosed BSI was assessed over a subsequent 6-24 months.
REDs prevalence was 55% green, 36% yellow, 5% orange and 4% red light. The CAT2 identified a greater prevalence of amenorrhoea and BSI and lower T3, testosterone and BMD (p<0.01) in red, orange and yellow (those with REDs) versus green light. ORs for a prospective self-reported BSI (majority physician diagnosed) were greater in orange vs green (OR 7.71, 95% CI (1.26 to 39.83)), in females with severe amenorrhoea (OR 4.6 (95% CI 0.98 to 17.85)), in males with low sex drive (OR 16.0 (95% CI 4.79 to 1038.87)), and athletes with elevated EDE-Q global scores (OR 1.45 (95% CI 0.97 to 1.97)).
The CAT2 has high validity in demonstrating current severity of REDs, with increased future risk of self-reported BSI in athletes with a more severe REDs traffic light category.
本横断面回顾性和前瞻性研究采用2023年国际奥委会运动中相对能量缺乏（REDs）临床评估工具第2版（CAT2），以确定精英运动员中REDs的当前严重程度（主要结果）和未来发生骨应力损伤（BSI，探索性结果）的风险。
女性（n = 143；23.3±4.3岁）和男性（n = 70；23.1±3.7岁）运动员（表现等级为3级（52%）、4级（36%）、5级（12%））参加了基线CAT2（有 minor modifications）评估，包括一份自我报告问卷（月经功能（女性）、BSI、饮食失调检查表问卷（EDE-Q））、骨密度（通过双能X线吸收法测定BMD）和空腹血液分析（三碘甲状腺原氨酸（T3）、睾酮、胆固醇）。通过CAT2为运动员分配绿灯、黄灯、橙灯或红灯。在随后的6 - 24个月内评估医生诊断的BSI新自我报告的前瞻性风险。
REDs患病率为绿灯55%、黄灯36%、橙灯5%和红灯4%。CAT2显示，与绿灯相比，红灯、橙灯和黄灯（即有REDs者）中闭经和BSI的患病率更高，T3、睾酮和BMD更低（p<0.01）。橙灯组与绿灯组相比，前瞻性自我报告的BSI（大多数由医生诊断）的比值比更高（OR 7.71，95%置信区间（1.26至39.83）），重度闭经女性中（OR 4.6（95%置信区间0.98至17.85）），性欲低下男性中（OR 16.0（95%置信区间4.79至1038.87）），以及EDE-Q全球评分升高的运动员中（OR 1.45（95%置信区间0.97至1.97））。
CAT2在显示REDs的当前严重程度方面具有较高的效度，REDs交通灯类别越严重的运动员，未来自我报告的BSI风险越高。
